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Updated: Oct 20 2021

Hyperaldosteronism / Conn Syndrome

  • Snapshot
    • A 27-year-old male presents with headaches, muscle weakness, and high blood pressure. A basic metabolic panel showed a Na+ of 147 and K+ of 3.1. CT of the abdomen demonstrates bilateraly adrenal hyperplasia.
  • Introduction
    • A disease caused by overproduction of aldosterone
    • May be of primary or secondary causes
      • primary hyperaldosteronism
        • direct secretion of unregulated aldosteronism
        • majority are caused by unilateral adrenal (zona glomerulosal) adenoma
          • also known as Conn's syndrome
        • also bilateral adrenal hyperplasiaof zona glomerulosa
      • secondary hyperaldosteronism
        • increased secretion of aldosterone as a result of increased stimulation by renin
        • seen in renal artery stenosis and CHF
          • the kidneys see an effective "low circulating volume state" and respond by activating the renin-angiotensin-aldosterone axis.
  • Presentation
    • Symptoms
      • headache
      • muscle weakness
        • secondary to hypokalemia
    • Physical exam
      • hypertension
        • hypernatremic hypertension
  • Evaluation
    • Labs
      • hypokalemia
      • +/- hypernatremia
        • hypernatremia is rarely found due to compensatory diuresis and resulting sodium loss secondary to increased circulating volume.
      • plasma renin
        • primary hyperaldosteronism
          • low renin
            • negative feedback inhibition by high aldosterone
        • secondary hyperaldosteronism
          • high renin
      • elevated 24-hour urine aldosterone
      • metabolic alkalosis
        • due to dumping of H+ for Na+
  • Treatment
    • Spironolactone
      • indications
        • indicated to normalize blood pressure and hypokalemia
      • mechanism
        • spironolactone is an aldosterone receptor antagonist
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